LITTLE ROCK (AP) — A consultant's report on the State Hospital released Wednesday blames top managers for not meeting minimum standards of patient care, even after repeated warnings from regulators and nearly losing the hospital's Medicare funding.

The 68-page report by Cincinnati-based Compass Clinical Consulting said senior executives weren't prepared for their roles and didn't get the training they needed to succeed. The report praised top leaders for the way they interacted with patients and got along with the staff, but said they didn't' have the leadership skills to make the sweeping changes the hospital needed.

The hospital's board also got its share of criticism for its "lack of understanding of its role in oversight activities" and for being unwilling to challenge top managers.

The Department of Human Services responded to the report by noting a series of changes it made, including a June shakeup in which the director and the behavioral health director resigned.

Board members now go through an orientation program to acquaint themselves with their responsibilities and the makeup of the panel has changed to include members with outside expertise in how to run a hospital, DHS said in its response.

The report said its criticisms didn't apply to current director Randall Fale, who is serving in a one-year interim role.

The Disability Rights Center of Arkansas, a nonprofit watchdog agency largely funded by the federal government, has long taken issue with how the hospital cares for patients.

The group earlier this year cited examples of patient abuse that were documented on video. One incident included a suicidal juvenile who was improperly put into isolation and bloodied his face. Another involved a mentally disabled 13-year-old who was made to sit in his own urine while he ate.

The hospital froze admissions to its youth unit for patients with developmental disabilities who also needed treatment for mental illness and worked to place patients already in its care.

In June, DHS accepted the resignations of top hospital administrator Charles Smith and Division of Behavioral Health Director David Laffoon. That followed a report from the Centers for Medicare and Medicaid Services, which evaluates whether health facilities meet standards and qualify for payments from the government health care programs for the poor.

Inspectors said the hospital violated a patient's rights by not protecting him from a physical altercation with another patient, which put funding in "immediate jeopardy."

The hospital also didn't meet standards on its plans for patient treatment and for the level of patients' physical activity.

The consultant's report said there was "widespread acknowledgement among the clinical staff that treatment planning is weak."

The report said staff members were willing to let problems persist and didn't have an interest in standardizing processes to ensure consistency in how patients are treated. The report faulted workers for relying too much on group treatment, while the conditions of the patients were so varied that some would derive no benefit. The report also said there is not enough one-on-one interaction with patients.

"In a therapeutic environment, we expect a greater staff effort to interact with patients and demonstrate positive social experiences," the report states.

DHS said the hospital will hold meetings with workers to outline the problems in the report and emphasize that they need to be corrected.